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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
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Trigeminal microvascular decompression for short-lasting unilateral neuralgiform headache attacks
Giorgio Lambru1, Susie Lagrata1, Andrew Levy1
1Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
Brain : a Journal of Neurology
|March 24, 2022
Summary
Trigeminal microvascular decompression offers a safe and effective treatment for refractory short-lasting unilateral neuralgiform headache attacks. Surgery significantly reduced headache frequency in most patients, particularly those with MRI-visible trigeminal neurovascular conflict.
Area of Science:
- Neurosurgery
- Neurology
- Headache Medicine
Background:
- Short-lasting unilateral neuralgiform headache attacks (SUNHA) are often refractory to medical management.
- Ipsilateral trigeminal neurovascular conflict with morphological changes is implicated in SUNHA pathophysiology.
- Limited treatment options exist for patients with medically intractable SUNHA.
Purpose of the Study:
- To evaluate the efficacy and safety of trigeminal microvascular decompression (MVD) for refractory SUNHA.
- To assess MVD outcomes in patients with MRI-confirmed trigeminal neurovascular conflict.
- To identify predictors of surgical response and long-term outcomes in SUNHA patients.
Main Methods:
- An uncontrolled, open-label, prospective, single-centre study (2012-2020) included 47 patients with refractory SUNHA.
- Patients underwent MVD for ipsilateral trigeminal neurovascular conflict identified via MRI.
- Efficacy was measured by the proportion of patients achieving excellent (90-100% reduction) or good (75-89% reduction) weekly attack frequency reduction.
Main Results:
- Of 47 patients, 39 (78.0%) had MRI evidence of morphological changes in symptomatic trigeminal nerves.
- Postoperatively, 78.7% of patients achieved an excellent or good response; 66.0% were responders at final follow-up (mean 57.4 months).
- Responders were more likely to have no interictal pain (P=0.021) and morphological changes on MRI (P=0.001); absence of morphological changes predicted relapse (P=0.0001).
Conclusions:
- Trigeminal microvascular decompression is a safe and effective long-term treatment for SUNHA with MRI-evident neurovascular conflict and morphological changes.
- Surgical outcomes are favorable, with a high rate of sustained pain reduction and discontinuation of preventive medications.
- The presence of morphological changes on MRI is a significant predictor of positive surgical outcomes and reduced relapse rates.
